Op-Ed: The mental health of frontline workers

Friday, June 5, 2020 - 2:38pm

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There is a massive mental health crisis brewing as COVID-19 sweeps across our communities. While many of us are trying to follow ever-changing protocols at home, thousands of frontline workers are perpetually immersed in the pandemic, unable to escape the constant threat of exposure. The number of cases and deaths have overwhelmed our current healthcare infrastructure — but the depth of this unpreparedness goes far beyond not having enough masks

Healthcare workers must deal with a high daily influx of COVID-19 cases coming into hospitals with composure while patients and families are suffering. Their workload has skyrocketed, alongside a constant uncertainty of ever-changing protocols. Burnout is typical in the medical field even when there isn’t a crisis at hand, and with the added stress COVID-19 and government failures put on frontline medical workers, the emotional toll is going to be unprecedented. Since the sharp increase of cases in the United States in mid-March, these workers have had no time to process the emotional weight of the crisis, and have no time to seek psychiatric support.

Facing continuous, inescapable stress both in the workplace and interpersonally is having a devastating impact on healthcare workers. There are three critical psychological impacts: acute stress response, moral injury and post-traumatic stress disorder. Stress reactions range from physical symptoms like headaches to behavioral changes like drug and alcohol abuse. If these reactions are not recognized and confronted, feelings of guilt and shame can accumulate below the surface. Moral injury occurs when there is a betrayal of what is considered right — during this pandemic, healthcare workers have to consistently go against their own beliefs to uphold hospital protocol. Healthcare workers cannot touch, comfort or support their patients in ways they used to, and they must act as the liaison between families and patients that are separated at the door. 

While no family was allowed to enter the room of a dying 75-year-old COVID-19 patient, one nurse remained by his side. She held his hand and moistened his lips to help comfort him. Ultimately, “she held an iPad close to him, so he could see the face and hear the voice of a grief-stricken relative Skyping from the hospital corridor.” After he passed away, she wept in the secluded hallway. Coping with a moral injury takes time that frontline workers do not have. Finally, the unavoidable stress and moral injury they experience can lead to PTSD, a mental health disorder with symptoms similar to a traumatic brain injury, that severely alters how someone experiences stress. 

When someone experiences trauma and does not have the social or psychological support needed to process and manage the weight of its emotional impact, they can develop coping mechanisms to help relieve temporary frustration. However, the trauma can ultimately rewire the brain, leaving the nervous system on constant high alert for the next stressor. The residual effects of suppressing the impact of trauma does not aid healing, but rather creates a cacophony of physical and psychological symptoms that can be debilitating. PTSD is a mental health disorder that alters the function of the amygdala, which regulates emotions and stress responses. The hippocampus, critical for verbal declarative memory, is also highly sensitive to trauma. Additionally, PTSD can permanently alter the medial prefrontal cortex, which helps regulate emotions and behavior. 

It is critical that we take the time to educate ourselves about PTSD, anxiety disorders and the impact of trauma on one's well being while the rapidly churning news cycle buries the threat of the mental health crisis. Thanking the medical frontline heroes for their tireless work is a good first step, but we must effectively support these workers by actively listening to their struggles and addressing the structural failures of psychiatric care. 

In order to appropriately address the crisis at hand, we must provide ongoing and wide-scope care. According to Dr. Jessica Gold, an assistant professor psychiatry at Washington University in St. Louis, that includes “preventive measures (stress reduction, mindfulness, and educational materials), in-the-moment measures (hotlines, crisis support), and treatment (telepsychiatry for therapy, and medication if needed).” As a community, we must collectively work to destigmatize mental illness and seeking treatment and choose to be supportive rather than dismissive. We need to check in and be prepared to actively listen to the struggles and traumas these workers are willing to share, even when it is painful. Keeping a strong support system is difficult during this time of social distancing, but it is critical for the successful recovery of frontline medical workers. 

In the United States, mental illness is slowly becoming less stigmatized. However, the progress toward acknowledging and confronting mental illness is not urgent enough. Instead of swallowing spoonfuls of acceptance, we collectively must embrace the scope of mental illness and consider the psychological, interpersonal and communal toll it takes. As someone who has been diagnosed with PTSD, I strongly urge you to educate yourself about this disorder and other mental illnesses. Medical frontline workers are facing an uphill battle in the coming months — the least we can do is actively recognize the exponential pain and suffering they encounter, and learn how to properly support them during this period of uncertainty.  

Elizabeth Cook is a junior in the College of Literature, Science & the Arts and can be reached at elizcook@umich.edu.